P652Lower use of statins among patients with peripheral artery disease compared with those with coronary heart disease

Background

Adults with atherosclerotic cardiovascular disease are recommended to take a statin to reduce their risk for future cardiovascular events. Prior studies suggest that statins are being taken by most adults with coronary heart disease (CHD). However, there are few data on the use of statins among adults with peripheral artery disease (PAD).

Purpose

To compare the use of statins among US adults with a history of PAD versus those with a history of CHD.

Methods

We conducted a retrospective cohort study among US adults ≥19 years of age with commercial or government health insurance who had a history of CHD or PAD as of December 31, 2014 (n=1,006,451, mean age 63 years, 47% male). We used pharmacy claims between January 1 and December 31, 2014 to identify use of any statin and of a high-intensity statin (i.e., atorvastatin 40–80 mg, rosuvastatin 20–40 mg, simvastatin 80 mg). Patients with a history of CHD without PAD (CHD only), both CHD and PAD, and PAD without CHD (PAD only) were analysed. Prevalence ratios for use of any statin and a high-intensity statin among those taking a statin were calculated after multivariable adjustment for sociodemographics and cardiovascular risk factors.

Results

Overall, 69.1% of patients included in the current analysis had CHD only, 21.4% had both CHD and PAD, and 9.5% had PAD only. Overall, 66.0%, 68.2% and 47.5% of patients with CHD only, CHD and PAD, and PAD only were taking a statin. After multivariable adjustment and compared to patients with CHD only, the prevalence ratio for statin use was 1.02 (95% CI 1.01, 1.02) for those with both CHD and PAD and 0.82 (95% CI 0.82, 0.83) for those with PAD only. Among patients taking a statin, 29.4% of those with CHD only, 28.6% of those with both CHD and PAD, and 17.3% of those with PAD only were taking a high-intensity dosage. Compared to patients with CHD only, the multivariable adjusted prevalence ratio for taking a high-intensity dosage was 1.05 (95% CI 1.04, 1.06) for those with both CHD and PAD and 0.71 (95% CI 0.70, 0.73) for those with PAD only.

Conclusion

Adults with PAD receive less intensive statin therapy compared with their counterparts who have CHD. Interventions aimed to increase statin use among patients with PAD are warranted.

Acknowledgement/Funding

This study was supported through a research grant from Amgen, Inc. (Thousand Oaks, CA, USA).

Gut microbiota composition and bone mineral loss-epidemiologic evidence from individuals in Wuhan, China

We explored the association between gut microbiota composition and bone mineral loss in Chinese elderly people by high-throughput 16S ribosomal RNA (rRNA) gene sequencing. Compared with controls, a smaller number of operational taxonomic units (OTUs), several taxa with altered abundance, and specific functional pathways were found in individuals with low-bone mineral density (BMD).

INTRODUCTION

Gut microbiota plays important roles in human health and associates with a number of diseases. However, few studies explored its association with bone mineral loss in human.

METHODS

We collected 102 fecal samples from each eligible individual belonging to low-BMD and control groups for high-throughput 16S rRNA gene sequencing.

RESULTS

The low-BMD individuals had a smaller number of OTUs and bacterial taxa at each level. At the phylum level, Bacteroidetes were more abundant in the low-BMD group; Firmicutes were enriched in the control group; Firmicutes and Actinobacteria positively correlated and Bacteroidetes negatively correlated with the BMD and T-score in all subjects. At the family level, the abundance of Lachnospiraceae in low-BMD individuals reduced and positively correlated with BMD and T-score; meanwhile, BMD increased with increasing Bifidobacteriaceae. At the genus level, low-BMD individuals had decreased proportions of Roseburia compared with control ones (P < 0.05). Roseburia, Bifidobacterium, and Lactobacillus positively correlated with BMD and T-score. Furthermore, BMD increased with rising abundance of Bifidobacterium. Functional prediction revealed that 93 metabolic pathways significantly differed between the two groups (FDR-corrected P < 0.05). Most pathways, especially pathways related to LPS biosynthesis, were more abundant in low-BMD individuals than in control ones.

CONCLUSIONS

Several taxa with altered abundance and specific functional pathways were discovered in low-BMD individuals. Our findings provide novel epidemiologic evidence to elucidate the underlying microbiota-relevant mechanism in bone mineral loss and osteoporosis.

[The effect of air test and methylene blue perfusion test on detecting the quality of anastomosis during laparoscopic rectal cancer excision (Dixon)]

Objective: To investigate the feasibility and safety of air test (AT) and methylene blue perfusion test (MBPT) to detect the quality of the anastomosis in laparoscopic rectal cancer excision (Dixon), and compare the two approaches. Methods: AT is performed by filling the pelvis with saline solution and insufflating the rectum with air through a size 22 G balloon catheter (Foley). MBPT is carried out by surrounding clean sponges around anastomosis and injecting methylene blue solution into the rectum as like as AT. The balloon catheter connected manometer,ensuring the pressure in rectum can reach 40 cmH(2)O during AT and MBPT. The presence of air bubbles and overt blue-stained spillage indicated anastomotic leaks which are were resolved during surgery. All 28 patients undergoing laparoscopic rectal excision received both AT and MBPT intraoperatively in a randomized fashion. The integrity of the anastomosis, postoperative vital signs, blood examination, drainage and postoperative imaging were analyzed. Results: All 28 patients received both tests successfully with no adverse event. MBPT Level 1 was detected in 15 cases, level 2 in 8 cases, level 3 in 5 cases. No MBPT level 4 was observed. AT level 1 was detected in 22 cases, level 2 in 5 cases, level 3 in 1 cases. No AT level 4 was founded. Three cases were diagnosed with postoperative anastomotic leakage (3/28, 10.71%), of which 2 cases were Grade B [definition and grading proposed by the international study group of rectal cancer (ISREC) in 2010]. One case was Grade C. The positive rate of MBPT was superior to AT (the McNemar testing, P<0.01). Conclusions: The two intraoperative tests are both technically feasible and safe. Compared to AT, MBPT has the advantage of localizing the leak site with a higher positive accuracy, and represents a promising standardized approach for intraoperative test of the anastomosis quality. Intraoperative repair is absolutely helpful for the level 3 and 4 intraoperative tests.

Simplified colonic dialysis with hemodialysis solutions delays the progression of chronic kidney disease

BACKGROUND

The colon plays a vital role in the disposal of nitrogenous waste products. Therefore, the colon may provide a therapeutic target for managing chronic kidney disease (CKD).

AIM

To evaluate the efficacy of a simplified model of colonic dialysis with hemodialysis solutions (SCD) to delay the progression of stages 3-5 CKD.

DESIGN

Retrospective study.

METHODS

We retrospectively analyzed 178 stages 3-5 CKD patients who did or did not receive SCD (SCD group, n = 88; control group, n = 90). The follow-up was 36 months. The outcome of CKD progression was defined as a decrease in 50% or more in estimated glomerular filtration rate, starting hemodialysis or peritoneal dialysis or undergoing transplantation. The Kaplan-Meier analysis was used to compare CKD progression between SCD and control groups as well as between subgroups at different CKD stages. Cox proportional hazard models adjusted for patients' characteristics were used to examine the association between SCD and the outcome.

RESULTS

For all patients, the outcome was significantly better in SCD group compared to control group (P < 0.05). The results were similar in the subgroups of patients at stage 4 (P = 0.001) and stage 5 (P = 0.000), but not in the subgroup of patients at stage 3 (P = 0.121). For all patients, SCD was associated with a lower risk of CKD progression after adjusted for patients' characteristics (adjusted hazard ratio, 0.373; 95% confidence interval, 0.201-0.694; P 0.002).

CONCLUSION

SCD is an effective supplementary therapy to delay the progression of stages 4-5 CKD.

[Real-world research on cervical cancer screening program and effect evaluation for Chinese population]

Objective: To evaluate the actual efficacy of cervical cancer and precancerous lesions screening approaches in real-world regions with different economic levels in China. Methods: The demonstrative application and effect evaluation of cervical cancer screening program were conducted in 21 hospitals nationwide from 2015 to 2018. Multi-stage sampling method was adopted to divide the country into 7 large areas according to geographical location. Two to four screening sites of two types of cancer (cervical cancer and breast cancer) were selected in each area, and the grassroots screening sites were implemented under the guidance of superior hospitals. In rural areas, women were initially screened using cytology, human papillomavirus (HPV) testing and visual inspection. The women with positive cytology or visual inspection were referred for colposcopy, and the women with positive HPV infection were randomly referred for reflex cytology or visual inspection, or direct colposcopy examination. In urban areas, women were primarily randomized into cytology or HPV testing groups. The women with abnormal cytology or positive HPV 16/18 infection were directly referred for colposcopy examination, whereas the women with positive infection of the other 12 high-risk subtypes of HPV were referred for reflex cytology or colposcopy. All of recruited women would be follow-up and screened by the baseline screening techniques in the third year while the positive women underwent colposcopy examination. The positive rates, referral rates, the detection rates of grade 2 and above of cervical intraepithelial neoplasia (CIN 2+ ) were compared. Results: A total of 63 931 women were recruited at the baseline. Among them, 11 rural sites included 33 823 women: 15 577, 11 157 and 7 089 women were screened by HPV testing, visual inspection via acetic acid or Lugol's iodine (VIA/VILI) and cytology, respectively. Additionally, 30 108 women were from 10 urban sites: 9 907 and 20 201 women were screened by cytology and HPV subtyping, respectively. The HPV positive rate for urban women was 9.34%, whereas that for rural women was 12.53%. The abnormal rate of cytology for urban women was 5.63%, and that for rural women was 4.24%. The positive rate of VIA/VILI in the rural women was 12.25% Furthermore, the detection rate of CIN2+ at the baseline was 0.56%, and that was statistically higher in HPV-positive group than cytology-positive group (P<0.05). Conclusions: All of screening sites completed the baseline screening tasks as expected. The prevalence of HPV infection is higher in rural women than urban women. The performance of HPV testing is better than cytology for detecting CIN2+ cases. This real-world demonstration study provides evidences for cervical cancer prevention and control in different regions.

Genomewide analysis of 6-methyladenine DNA in peripheral blood mononuclear cells of systemic lupus erythematosus

Aim

The aim of this paper is to explore the expression of 6-methyladenine (6mA) DNA and to elucidate its gene regulation role in systemic lupus erythematosus (SLE).

Methods

Twenty SLE patients and 20 normal control healthy individuals (HCs) were included in this study. Genomic DNA was isolated from peripheral blood mononuclear cells and subsequently underwent 6mA-immunoprecipitation-sequencing (6mA-IP-Seq) after DNA quality control and 6mA precipitation. Bioinformation analysis was applied to the raw data comparing 6mA levels between SLE patients and HCs.

Results

We identified 5462 hypermethylation and 431 hypomethylation genes in PBMCs of individuals with SLE, which indicated that a high level of 6mA participates in the pathogenesis of SLE. Gene ontology analysis revealed that hypermethylation genes might regulate the inflammatory process, which has been well documented in the pathogenesis of SLE.

Conclusion

6mA may be involved in the initial development of SLE, which may lead to its potential use as an early diagnostic marker and therapeutic target.

Reliable model established depending on soil properties to assess arsenic uptake by Brassica chinensis

Generally, prediction of arsenic (As) bioavailability, mobility and its transfer from soil to plant is very important with respect to management of environment and food safety. In this study, pakchoi (Brassica chinensis) was sown in a greenhouse to evaluate the As transfer characteristics from different soils to plant system, and to investigate the possible prediction equations and key factors involved in As bioavailability. The results showed that As uptake of plant and soil As concentration was significantly and positively correlated (R² = 0.778; P < 0.01). A log-transformed data provided a better correlation (R² = 0.901; P < 0.01). Results obtained from stepwise multiple linear regression (SMLR) showed that soil pH and total As were important variables involved in the contribution of As transfer to plant. The As accumulation in plant exhibited a positive correlation with soil As content and pH. Various prediction equations were obtained from different As sources, whereas the most favourable equation was screened by root mean square error (RMSE) between the measured and predicted Log [plant As] content. The prediction model (Log [plant As] =1.34 Log [soil As] +0.18pH-1.25) showed the greatest accuracy of R² = 0.978 and RMSE = 0.11, by combining the data of three As treatments (45 observed data points). These current findings are quite useful and could be used for predicting the As transfer from soil to plant system.

Differentially expressed long non-coding RNAs and the prognostic potential in colorectal cancer

Colorectal cancer (CRC) is a disease with high incidence, especially in developed countries. Long non-coding RNAs (lncRNAs) are new research hotspots for their vital roles in regulating gene expression. This study aims to investigate the prognostic value of lncRNAs in CRC patients. A total of 21 cancer-related lncRNAs were detected by PCR array to reveal their expression changes in CRC tissue. A 120-week-long follow-up was performed in 30 CRC patients to analyze the relationship between lncRNA levels and CRC prognosis. Most of the 21 lncRNAs were differentially expressed in CRC tissue compared to the adjacent normal tissue, among which seven lncRNAs were significantly changed: AFAP1-AS1, BCAR4, H19, HOXA-AS2, MALAT1 and PVT1 were up-regulated, and ADAMTS9-AS2 was down-regulated in CRC tissue samples. No obvious correlation was found between lncRNA levels and the age, gender, tumor size or TNM stage of these patients. Log-rank test indicated that higher levels of AFAP1-AS1, BCAR4, H19, HOXA-AS2, MALAT1 or PVT1 and lower level of ADAMTS9-AS2 might predict the poor prognosis of CRC patients. This study suggests the potential value of the seven lncRNAs in the prognosis of CRC, providing reference information for future research on CRC prognostic and treatment strategy.

[The function-structure impairment pattern of optic nerves in primary open-angle glaucoma and normal-tension glaucoma]

Objective: To investigate the characteristics of impairment of the visual field (VF) and retinal nerve fiber layer (RNFL) and the differences of progression pattern of early, middle and late stages of primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) , and to analyze the correspondence of structure and function. Methods: Cross-sectional study. POAG patients, NTG patients and healthy volunteers who were enrolled from February 2008 to May 2017 at Department of Ophthalmology, Eye & ENT Hospital of Fudan University, underwent basic ophthalmic examination, Humphrey central 24-2 threshold test and optical coherence tomography. Patients were divided into early, middle and late stages according to the mean defect (MD) index of the VF test. According to the RNFL distributional characteristics, the pattern deviation map and RNFL were divided into 6 sectors. The differences of each sector's MD and RNFL thickness in the healthy group and groups of patients at 3 stages were analyzed using the Kruskal-Wallis test, and the correlation of MD and RNFL thickness of each sector was analyzed using the Pearson coefficient. Results: In the POAG group, there were 84 cases (84 eyes) including 35 eyes of early stage, 20 eyes of middle stage and 29 eyes of late stage, with a male/female ratio of 43∶41, aged (45±15) years. In the NTG group, 69 cases (69 eyes) included 30 eyes of early stage, 20 eyes of middle stage and 19 eyes of late stage, with a male/female ratio of 33∶36, aged (49±13) years. The control group had 23 cases (23 eyes), with a male/female ratio of 16∶17 and an age of (44±10) years. There was no significant difference in male/female ratio, age or best corrected visual acuity among the three groups. (1) In the middle stage of POAG, the VF defects of inferior hemi-fields were more severe than the superior (t=21.62, P=0.000), which was opposite to the late stage of POAG (t=-3.28, P=0.003). In each stage of NTG, there was no significant difference between two hemi-fields. In the control group, the MD values(antilog) of VF in the superior peripheral arch (PEA), superior paracentral arch (PAA), inferior PEA and PAA, temporal and central regions were 0.87 (0.63-1.11)/L, 0.74 (0.61-0.83)/L, 0.72 (0.55-0.97)/L, 0.65 (0.51-0.87)/L, 0.69 (0.57-0.97)/L, and 0.82 (0.54-0.93)/L, respectively. The sectoral MD values in the VF sectors of POAG were significant compared with the control group (P<0.05): superior PAA for early stage [0.61 (0.18-0.92)/L, H=21.58], superior PEA and PAA for middle stage [0.61 (0.15-0.87)/L, 0.21 (0.00-0.78)/L, H=25.99, 34.91], superior PEA and PAA, inferior PEA and PAA for late stage [0.01 (0.00-1.13)/L, 0.00 (0.00-0.76)/L, 0.41 (0.00-1.07)/L, 0.21 (0.00-0.95)/L, H=46.27, 54.19, 25.64, 28.10]. With the aggravation of POAG, superior PAA had the largest reduction percentage of sectoral MD. The sectoral MD values in the VF sectors of NTG were significant compared with the control group (P<0.05): superior PAA for early stage [0.54 (0.19-0.80)/L, H=20.93], superior PAA for middle stage [0.60 (0.02-1.01)/L, H=22.13], superior PEA and PAA, inferior PEA and PAA for late stage [0.33 (0.00-0.90)/L, 0.05 (0.00-0.92)/L, 0.16 (0.01-0.87)/L, 0.64 (0.02-1.10)/L, H=37.66, 42.78, 35.15, 37.15]. With the aggravation of NTG, the largest reduction percentage of sectoral MD was found in superior PAA at the beginning but in inferior PAA at last. (2) The RNFL thickness of the control group in Region 1NI, 2TI, 3NS, 4TS, 5N, and 6T was 112.76 (63.54-150.99) μm, 134.89 (89.44-198.55) μm, 96.52 (57.32-158.79) μm, 120.96 (69.25-148.48) μm, 71.85 (65.03-95.47) μm, and 66.24 (55.44-90.97) μm, respectively. The sectoral thickness in the RNFL sectors of POAG were significant compared with the control group (P<0.05): 2TI for early stage [109.17 (43.77-173.86) μm, H=31.50], 1NI, 2TI and 4TS for middle stage [71.54 (49.92-94.98) μm, 62.92 (42.33-102.73) μm, 84.20 (45.98-120.13) μm, H=38.91, 49.89, 30.60], 1NI, 2TI, 3NS, 4TS, 5N and 6T for late stage [61.76 (39.32-97.99) μm, 59.59 (42.80-108.69) μm, 67.28 (42.56-117.96) μm, 65.16 (41.96-138.02) μm, 59.45 (21.04-78.48) μm, 53.74 (27.88-92.71) μm, H=52.76, 55.06, 35.76, 41.72, 41.32, 29.93]. With the aggravation of POAG, at the beginning 2TI had the largest reduction percentage of RNFL thickness but 4TS had it at last. The sectoral thickness in the RNFL sectors of NTG were significantly different from the control group (P<0.05): 2TI for early stage [78.97 (47.77-131.45) μm, H=28.86], 1NI, 2TI, 3NS and 4TS for middle stage [61.46 (49.69-97.38) μm, 74.51 (40.25-135.16) μm, 86.36 (42.70-105.06) μm, 83.60 (54.75-117.35) μm, H=38.76, 35.64, 22.47, 24.14], 1NI, 2TI, 3NS, 4TS and 6T for late stage [61.45 (49.09-92.64) μm, 54.35 (37.40-102.62) μm, 63.72 (28.68-105.55) μm, 61.00 (44.92-108.49) μm, 50.33 (35.62-82.09) μm, H=42.56, 51.50, 36.11, 47.44, 25.50]. With the aggravation of NTG, the sector with the largest reduction percentage of thickness changed from 2TI to NI and 4TS. (3) The VF superior PAA-RNFL 2TI had the highest Pearson correlation coefficient in POAG (r=0.630, P<0.001), while it was the inferior PAA-4TS in NTG (r=0.645, P<0.001). Conclusions: The impairment patterns of VF and RNFL in each stage of POAG and NTG are distinctly different from certain rules of aggravation. The sector with the strongest correlation of function-structure is the VF superior PAA-RNFL inferior temporal sector in POAG and inferior PAA-superior temporal sector in NTG. (Chin J Ophthalmol, 2018, 54: 811-819).

[Comparative analysis of anatomic and non-anatomic hepatectomy for single small hepatocellular carcinoma with microvascular invasion]

Objective: To compare the efficacy and safety of anatomic hepatectomy and non-anatomic hepatectomy in the treatment of single small Hepatocellular carcinoma with MVI. Methods: The clinical data of 84 patients with single small Hepatocellular carcinoma with MVI in Beijing Chaoyang Hospital between January 2008 and December 2013 were retrospectively analyzed. Patients undergoing anatomical hepatectomy were enrolled in the AR group, and the patients undergoing non-anatomic hepatectomy were enrolled in the NR group. The efficacy and survival rate of the two groups were compared. Results: (1) Operation time, numbers of patients with volume of intraoperative blood loss ≥300 ml and number of patients with blood transfusion were (170±41)minutes, 8, 7 in the AR group and (148±35)minutes, 19, 18 in the NR group, respectively, with statistically significant differences between the 2 groups (P<0.05). (2) The 1-year, 2-year and 3-year overall survival rate were 85.7%, 68.6%, 57.1% in the AR group and 79.6%, 53.1%, 42.9% in the NR group, respectively. The 1-year, 2-year and 3-year progression-free survival rate were 80.0%, 62.9%, 51.4% in the AR group and 71.4%, 49.0%, 38.8%, in the NR group, respectively. There were statistically significant differences between the 2 groups both in the overall survival rate and the progression-free survival rate (P<0.05). (3) Prognostic factors analysis of HCC patients with MVI: result of univariate analysis showed that maximum diameter of tumor and surgical procedures were relative factors affecting overall survival and progression-free survival of HCC patients with MVI, AFP level was relative factors affecting progression-free survival of HCC patients with MVI, with statistically significant differences (P<0.05). Result of multivariate analysis showed that maximum diameter of tumor between 3.0 and 5.0 cm and non-anatomic liver resection were independent factors affecting poor overall survival and progression-free survival of HCC patients with MVI, and AFP≥20 μg/L and total bilirubin ≥20 μmol/L were independent factors affecting poor progression-free survival of HCC patients with MVI, with a statistically significant differences (P< 0.05). Conclusion: Anatomic hepatectomy for patients with single small hepatocellular carcinoma with microvascular invasion has better clinical efficacy and safety.

Clinical application of protein biomarkers in lupus erythematosus and lupus nephritis

Systemic lupus erythematosus (SLE) is a type of autoimmune disease that damages multiple organs, including the heart, joints, liver and kidneys. The main characteristics of SLE are the deposition of circulating autoantibodies; autoantigen complexes in the renal system; and abnormal expression of complements, cytokines and chemokines. Lupus nephritis (LN) is the most serious manifestation of SLE and is characterized by inflammation of the kidney. This review summarizes recent clinical applications of protein biomarkers including autoantibodies, complements, cytokines and chemokines and some new protein biomarkers in SLE and LN. The clinical differential diagnosis of protein biomarkers related to prognosis and diagnosis is discussed and highlighted. Protein biomarkers play crucial roles in the study of SLE and LN. Useful biomarkers will provide insights into effective treatments for these diseases.